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To receive a baclofen pump, a programmable device that delivers medication continuously, you will need a procedure lasting approximately 1 to 2 hours and a hospital stay.
Factors Your Doctor May Consider
Your doctor will consider many factors including your symptoms, goals, body mass, and results of a screening test. More
Your Healthcare Team
With ITB therapy, a variety of healthcare providers will work together to help manage your severe spasticity caused by stroke. More
Surgery: What to Expect
On average, the surgery to implant ITB therapy takes about 1 to 2 hours from start to finish. Your doctor can answer any questions you may have about the procedure. More
Factors Your Doctor May Consider — Intrathecal Baclofen Therapy
Your doctor will consider many important factors to decide if intrathecal baclofen therapy is right for you.
Eligibility Requirements
You may be a candidate for ITB therapy if you:
Have severe spasticity that interferes with your function, care and comfort, or activities of daily living
Show a positive response to a baclofen injection in a standard screening test
Have sufficient body size to support the pump, which must be implanted 2.5 centimetres (1 inch) or less from the surface of the skin
Do not have any infection
Are not allergic to baclofen
Oral baclofen is no longer working for you
In addition, healthcare professionals may use the following criteria to determine if you are a candidate for a baclofen pump:
You experience severe spasticity or spasms that interfere with function or daily activities
Your severe spasticity or spasms interfere with care or positioning
About the Screening Test
A standard screening test determines if ITB therapy may work for you. During the test, you'll be screened with a small dose of the drug called baclofen injected into the intrathecal space (where fluid flows around the spinal cord).
If You Are a Candidate
If your doctor determines you are a candidate for a baclofen pump, you will need to make the final decision about whether to pursue the therapy.
Here are some suggestions to help you decide if a baclofen pump is right for you:
Talk with people who have a baclofen pump.
Make sure you're comfortable with your doctor. He or she should be helpful, supportive, and ready to answer any questions you may have.
Carefully weigh the benefits and risks of a baclofen pump.
Before you meet with your doctor, think about what you hope to learn. Prepare questions, and be ready to provide information about your medical history.
You'll work with a variety of healthcare professionals to determine if you are a suitable candidate for ITB therapy. They’ll thoroughly evaluate your condition to find the most appropriate treatment options. To get the best results, it's important to actively participate in discussions and decision-making related to your care.
Your healthcare team for severe spasticity treatment with a baclofen pump may be a combination of the following:
Individual and Family Caregivers
Goal setting
Treatment decisions
Neurologist, Rehabilitation Specialist, or GP
Refers the individual for a spasticity evaluation
Goal setting
Treatment decisions
Post-surgery monitoring
Coordination of spasticity management with other aspects of care
May be involved in assessment and management of the baclofen pump
Neurosurgeon or Orthopaedic Surgeon
Surgically places the pump
May be involved in assessment and management of the baclofen pump
Surgery: What to Expect – Implanting the Baclofen Pump
Surgery to implant a baclofen pump takes approximately 1 to 2 hours from start to finish, depending on individual surgical techniques. Your doctor will be able to answer any questions you may have about the specifics of your procedure.
Before the Procedure
Your surgery to receive a baclofen pump may require a brief hospital stay, or it may be done on an outpatient basis. Before the procedure, you and your doctor will decide where to position the pump for your comfort.
During the Procedure
Typically, the surgery is performed under general anaesthesia, but you may discuss alternatives with your doctor. During surgery, the pump will be placed just under the skin of your lower abdomen.
The pump will be connected to a flexible silicone tube called a catheter. The catheter is threaded beneath the skin into the intrathecal space (around the spinal cord), into which it will deliver the medication.
After the Procedure
After surgery, you'll feel some discomfort and tenderness at the pump and catheter sites. Your doctor may prescribe medication to relieve any pain caused by surgery and antibiotics to prevent infection. Tell your doctor if you notice any swelling, pain, or redness near your incision.
Depending on your doctor's preference, the pump may be filled during or after surgery. However, some doctors recommend a short waiting period to allow you to recover from surgery and get adjusted to the pump.
You'll begin receiving treatment as soon as the pump is filled with medication and the medication travels through the catheter to the intrathecal space. You may feel effects from the medication soon after delivery, or it may take a while for you to experience benefits. It may take several weeks to months to reach your optimal dose.
Drug Side Effects
ITB therapy drug side effects are usually temporary and may be managed by adjusting dosage.
The most common side effects include:
Loose muscles
Sleepiness
Upset stomach and vomiting
Headaches
Dizziness
Symptoms of Baclofen Withdrawal
Please follow your doctor's instructions closely because a sudden stop of intrathecal baclofen therapy can result in serious illness (baclofen withdrawal symptoms), such as:
High fever
Changed mental status
Muscle rigidity
Multiple organ-system failure and death (in rare cases)
It's important to keep your scheduled refill visits so you don't run out of medication (baclofen) and to understand the early symptoms of baclofen withdrawal, which include:
Increase or return in spasticity
Itching
Low blood pressure
Lightheadedness
Tingling sensation
Potential Device Complications
Once the infusion system is implanted, possible device complications may include:
Catheter or pump moving within the body or eroding through the skin
Leakage, tearing, kinking, or disconnection of the catheter resulting in underdose or lack of baclofen infusion
Pump failure leading to overdose or underdose of intrathecal baclofen
